Does your baby have tongue-tie or other oral connective tissue or fascial restrictions resulting in breastfeeding problems?
True tongue-tie (or ankyloglossia) sometimes causes breastfeeding problems but is not that common
Does your baby really have tongue-tie, posterior tongue-tie, lip-tie, buccal ties, or fascial restrictions which are causing breastfeeding problems? How can you sort this out when there's so much conflicting advice on this topic? What does the science actually tell us? What are the limitations to this science?
We definitely don't want to miss diagnosing and treating a classic tongue-tie in your baby. You can find out about tongue-tie, infant fascial restrictions, and other oral connective tissue restrictions in section of Possums Breastfeeding & Lactation which deals with this topic, starting here.
The research gives us wildly variable estimates of how many babies have tongue-tie because there is no clear definition
The true rate of tongue-tie is difficult to know, because there is no agreement in the research about how to define tongue-tie. Estimates range from 1.7% to 10.7% of babies, or even more.
Certainly at the moment, there are no reliable diagnostic screening tools for ankyloglossia, despite what you might hear - and worse, screening tools are often being wrongly used as diagnostic tools. As I write, none of the screening tools in use are based on accurate understandings of the biomechanics of infant suck and swallow in breastfeeding.
Tongue-tie is overdiagnosed and overtreated in babies
Tongue-tie and fascial restrictions are currently overdiagnosed and overtreated in breastfeeding babies in advanced economies. Sometimes you might read that rates of tongue-tie diagnosis and treatment have only increased because breastfeeding rates have increased, or because we are better at diagnosing it. You'll specially hear this said by health professionals who have a special interest in treating ankylofrenula.
This claim is not accurate. The research clearly demonstrates an exponential increase in numbers of infant frenotomies performed in various countries in recent years, which is consistent (applying the science of epidemiology) with overdiagnosis and overtreatment.
In bringing you Possums Breastfeeding & Lactation, I hope to help you avoid inaccurate diagnoses of tongue-tie and oral connective tissue or fascial restrictions, without missing a classic or true tongue-tie, and to help you avoid unnecessary expense and worry. I also hope to help protect your baby from the unnecessary side-effects of treatments - which can sometimes be severe, or even on rare occasions life-threatening.
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You can find out about possible side-effects of frenotomy, and why laser risks more side-effects than scissors, here.
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You can find out what drives overdiagnosis and overtreatment of tongue-tie and oral connective tissue restrictions here.
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You can find the help of an NDC Accredited Practitioner here.
It's not possible to tell if the baby in the photograph at the top of this page would benefit from a frenotomy, because a single image can be quite misleading. We can certainly see a prominent opaque anterior membrane, which would be easy to snip. The baby's tight lips don't tell us anything - other than at the moment of the photograph, this little one is somewhat dialled up and pulling in his lips defensively. He is holding his upper lip in tight at the moment the photo was taken. But this doesn't mean that his orbicularis oris muscles have developed abnormal or stressed or tight functional patterns, or that the behaviour of his lips is linked with the frenulum. A full assessment is required, including of breastfeeding (or, if relevant, bottle feeding). Infant oromotor function is contextual.
Recommended resources
Your baby's tongue doesn't cause friction, pinching, or compression during breastfeeding
Does your baby have a classic tongue-tie (or true ankyloglossia)?
Does your baby have a posterior tongue-tie?
Does your baby have an upper lip-tie or buccal ties?
Selected references
Borowitz SM. What is tongue-tie and does it interfere with breast-feeding? - a brief review. Frontiers in Pediatrics. 2023;11:1086942.
Delgadillo GJ, Rojoas JZ, Munozl MA, Luque-Martinez I. Frenotomy for ankyloglossia in children under five: a systematic review and metanalysis on breastfeeding outcomes. International Breastfeeding Journal. 2025;20(81):https://doi.org/10.1186/s13006-13025-00773-x.
Dinha LA, El-Rabbany M, Aslam S, Ricalde P. Does lingual frenotomy improve breastfeeding in newborns with ankyloglossia? A randomized controlled trial. Journal of Oral and Maxilliofacial Surgery. 2025:DOI: https://doi.org/10.1016/j.joms.2025.1004.1006.
Dixon B, Gray J, Elliot N, Shand B, Lynn A. A multifaceted programme to reduce the rate of tongue-tie release surgery in newborn infants: observational study. international Journal of Pediatric Otorhinolaryngology. 2018;113:156-163.
Ellehauge E, Schmidt Jensen J, Gronhoj C, Hjuler T. Trends of ankyloglossia and lingual frenotomy in hospital settings among children in Denmark. Danish Medical Journal. 2020;67(5):A01200051.
Fraser L, Benzie S, Montgomery J. Posterior tongue tie and lip tie: a lucrative private industry where the evidence is uncertain. BMJ. 2020;371:m3928.
Hill R, R, Lee CS, Pados BF. The prevalence of ankyloglossia in children aged < 1 year: a systematic review and meta-analysis. Pediatric Research. 2021;90(2):259-266.
Joseph KS, Kinniburg B, Metcalfe A, Raza N, Sabr Y, Lisonkova S. Temporal trends in ankyloglossia and frenotomy in British Columbia, Canada, 2004-2013: a population-based study. CMAJ Open. 2016;4:e33-e40
Kapoor V, Douglas PS, Hill PS, Walsh L, Tennant M. Frenotomy for tongue-tie in Australian children (2006-2016): an increasing problem. MJA. 2018;208(2):88-89.
Larrain M, Stevenson EGJ. Controversy over tongue-tie: divisions in the community of healthcare professionals. Medical Anthropology. 2022:DOI:10.1080/01459740.01452022.02056843.
Lisonek M, Shiliang L, Dzakpasu S, Moore AM, Joseph KS. Changes in the incidence and surgical treatment of ankyloglossia in Canada. Paedaitrics and Child Health. 2017;22(7):382-386.
Walsh J, Links A, Boss E, Tunkel D. Ankyloglossia and lingual frenotomy: national trends in inpatient diagnosis and management in the United States, 1997-2012. Otolaryngology Head and Neck Surgery. 2017;156(4):735-740.
Wei E, Tunkel D, Boss E, Walsh J. Ankyloglossia: update on trends in diagnosis and management in the United States, 2012-2016. Otolaryngology - Head and Neck Surgery. 2020:https://doi.org/10.1177%1172F0194599820925415.